Healthcare Provider Details

I. General information

NPI: 1306864145
Provider Name (Legal Business Name): LEO GASTON STINNETT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W TARGET RANGE RD
NOGALES AZ
85621-2466
US

IV. Provider business mailing address

1189 E MADERA ESTATES LN
SAHUARITA AZ
85629-6687
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-4747
  • Fax: 520-285-3136
Mailing address:
  • Phone: 803-332-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ0285
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27159
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: